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General NPI Number Information
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NPI Number | 1154916468
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Entity Type | Individual
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Provider Name | MR. TOLBERT MORRIS JR.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 1733 LAKE ROCKAWAY RD NW
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City | CONYERS
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State | GA
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Zip | 30012-3152
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Country | US
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Telephone | 678-607-7674
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Fax | 866-443-8670
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Provider Business Mailing Address
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Address Line | 1733 LAKE ROCKAWAY RD NW
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City | CONYERS
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State | GA
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Zip | 30012-3152
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Country | US
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Telephone | 678-607-7674
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Fax | 866-443-8670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 1962774083
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License Number State | GA
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